Individual
MR. CRAIG EUGENE PANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 335-3022
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
661244
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP111175
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168981203
—
TX
Enumeration date
08/03/2006
Last updated
01/24/2020
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